Volunteer Facilitator Application
Contact Details
First Name
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Last Name
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Email
Email Type
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Personal
Work
Mobile Phone
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Opt-In for Text Communication
Yes
Street Address
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City
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State
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Alabama
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District Of Columbia
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Vermont
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Washington
West Virginia
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Puerto Rico
Virgin Island
Northern Mariana Islands
Guam
American Samoa
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Zip Code
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Are you or have you been a Willow House Family Member? (i.e. have you attended / signed up for group support services?)
Yes
No
Employment
Current Employer
255 characters left.
Current Title
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Current Job Description
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Please list your previous volunteer experience
Organization (1)
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Type of Volunteer Work (1)
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Organization (2)
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Type of Volunteer Work (2)
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Organization (3)
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Type of Volunteer Work (3)
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Organization (4)
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Type of Volunteer Work (4)
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Volunteer with Willow House
How did you hear about Willow House?
Please select...
Counseling Professional
Friend/Family
Google/Online Search
Religious Organization
School
Social Media
Walk and 5K to Remember
WH Family Member
WH Staff/Intern
WH Board Member
WH Volunteer
Other
How did you hear about volunteer opportunities with Willow House
255 characters left.
Why are you interested in volunteering with grieving children & teens at Willow House?
32768 characters left.
Please describe your personal and professional experiences working with children and/or teens. Please specify age and duration.
32768 characters left.
Which traits and skills do you have that
you feel will be most applicable in working with children and teens?
32768 characters left.
Have you experienced the death of a family member or close friend?
Yes
No
How long has it been since the death(s)? Please also describe how the person(s) in your life died and how you coped with the experience(s)
32768 characters left.
Do you have any experience in the creative arts, fitness, health or alternative therapies? If so, please describe.
32768 characters left.
Do you have any clinical certifications or degrees? If so, please list each certification and degree with year & location obtained.
32768 characters left.
Have you ever been convicted of any felonies or misdemeanors other than for minor traffic offenses?
Yes
No
If yes, please explain
32768 characters left.
What is your current availability?
32000 characters left.
Please list and special skills/talents you have that may be helpful to Willow House.
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Any additional comments, concerns, or questions.
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Signature
Willow House requires that background checks be completed for all volunteers who are working directly with Willow House children and teens in the program setting. Your signature below indicates your understanding of this volunteer policy and your agreement to your name being submitted for a background check following your completion of the training.
Signature (Type Full Name)
255 characters left.
Date
Hidden Fields
Volunteer Contact Record Type Id
WH Family Member Contact Record Type Id
Vol Facilitator Case Record Type Id
General Volunteer Case Record Type Id
Contact Information
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